World Hepatitis Day 2024: In-Depth Interview with Dr. S K Sarin Part - 2

Summary

In this insightful discussion, Dr. Serin highlights the global impact of viral hepatitis, particularly in India, emphasizing the urgent need for action. He outlines the importance of distinguishing between infection and disease, the effectiveness of treatments for Hepatitis B and C, and the significance of India's National Viral Hepatitis Control Program. Dr. Serin advocates for increased public awareness, testing, and treatment to combat the stigma and reduce the high mortality rates associated with these chronic infections. He also stresses the importance of a 'whole of society' approach to eliminate hepatitis by 2030, treating all infected individuals to prevent transmission and new infections.

Takeaways

• 🌐 Globally, 96% of the 1.3 million hepatitis-related deaths are due to Hepatitis B and C, highlighting their significant impact on public health.
• 💉 Vaccination and immunization are critical in combating viral hepatitis, especially since Hepatitis A and E can be cleared by the body, unlike the chronic infections of Hepatitis B and C.
• 💊 Effective treatments exist for Hepatitis B and C, with Hepatitis C having a cure rate of 90-95% within 12 weeks using oral medications.
• 🇮🇳 India has a National Viral Hepatitis Control Program offering free testing, treatment, and monitoring for Hepatitis C, a privilege few countries provide.
• 🚫 The mindset of infected individuals often leads to unnecessary fear and avoidance of normal life activities, despite the fact that infection does not equate to disease.
• 📉 The risk of cirrhosis and liver cancer significantly decreases with proper treatment of Hepatitis B and C.
• 📈 Awareness and early detection are crucial for reducing hepatitis-related deaths, emphasizing the need for public education and participation.
• 📊 India's National Viral Hepatitis Control Program, despite being well-structured, requires more visibility and public engagement to be fully effective.
• 🌟 Celebrity involvement in awareness campaigns, similar to those for TB, could significantly boost public understanding and empathy towards hepatitis.
• 🏥 The healthcare system and government need to prioritize hepatitis prevention, screening, and treatment, especially in resource-constrained settings.
• 🎯 The goal is to eliminate hepatitis by 2030, which requires a whole-of-society approach, including education, testing, and treatment for all infected individuals.

Q & A

What is the global status of viral hepatitis, particularly in India?

Viral hepatitis, particularly Hepatitis B and C, is a significant public health issue with 96% of the 1.3 million deaths due to hepatitis being caused by these two types. India has a National Viral Hepatitis Control Program since 2018, which provides free testing, treatment, and monitoring for Hepatitis C.

What is the difference between Hepatitis A, B, C, and D in terms of infection persistence?

Hepatitis A and E are typically cleared by the body, while Hepatitis B, C, and D are chronic infections that persist for life unless treated. Hepatitis B treatment aims to suppress the virus, similar to HIV, with clearance being rare.

What is the significance of the theme 'Time to take action against hepatitis'?

The theme emphasizes the urgency to increase awareness, improve screening, and ensure treatment accessibility to combat the high mortality rate associated with Hepatitis B and C.

How effective are the current treatments for Hepatitis B and C?

For Hepatitis C, there are very effective drugs that can clear the virus within about 12 weeks, with a 90-95% clearance rate. Hepatitis B treatment involves daily medication to suppress the virus, significantly reducing the risk of cirrhosis and liver cancer.

What is the importance of distinguishing between being infected with Hepatitis B and having the disease?

It's crucial to differentiate because only 1 to 10% of those infected will develop the disease. Many infected individuals may not show symptoms and can live normal lives if the virus is suppressed with treatment.

Why is awareness and testing for Hepatitis C important, especially for certain groups?

Awareness and testing are important because Hepatitis C can be asymptomatic yet lead to severe liver damage or cancer. High-risk groups such as those who have received blood transfusions, IV drug users, and individuals who have undergone surgery should get tested.

What is the role of the Indian government in combating viral hepatitis?

The Indian government has established a National Viral Hepatitis Control Program that offers free hepatitis C drugs, testing, and monitoring. The program aims to increase visibility and awareness to reduce the stigma and improve public participation.

How can public figures and celebrities contribute to raising awareness about hepatitis?

Public figures like actors can have a significant impact on raising awareness by participating in campaigns, sharing their personal experiences, and advocating for the importance of testing and treatment.

What are the challenges faced by the National Viral Hepatitis Control Program in India?

While the program provides free services, challenges include low public participation, lack of awareness, and the stigma associated with hepatitis, which hinder early detection and treatment.

What is the significance of the 'WOM' program in hepatitis awareness?

The 'WOM' program involves women who are hepatitis positive becoming ambassadors to educate and support others. Their personal experiences make them effective in spreading the message and reducing fear and stigma.

What are the future aspirations for hepatitis care and management globally?

The aspiration is to treat all infected individuals, not just those with the disease, to reduce the pool of potential transmitters. This approach aims to eliminate hepatitis by the end of the century, ensuring future generations are free from hepatitis B and C.

Outlines

00:00

🌏 Global Status of Viral Hepatitis and Public Health Impact

The speaker discusses the global status of viral hepatitis, particularly in India, emphasizing the significant impact on public health. They highlight that 96% of the 1.3 million hepatitis-related deaths are due to hepatitis B and C, which are chronic infections that the body cannot clear without treatment. The speaker underscores the importance of vaccination and treatment, noting that effective drugs for hepatitis C can cure the infection within 12 weeks and significantly reduce the risk of cirrhosis and liver cancer. They also mention India's national viral hepatitis control program, which offers free testing, treatment, and monitoring, and stress the need for increased awareness and action to combat the disease.

05:00

📢 Raising Awareness and National Control Programs

This paragraph focuses on the need for greater visibility and awareness of hepatitis B, comparing its death rate to that of tuberculosis and malaria. The speaker advocates for strong public campaigns to educate about hepatitis, similar to those that have been successful for other diseases. They discuss India's National Viral Hepatitis Control Program, noting that while the government has provided free drugs and testing, public participation is lacking. The speaker calls for increased testing among high-risk groups and emphasizes the importance of early detection and treatment to prevent advanced liver disease and cancer.

10:05

👩‍🏫 Education and Community Outreach for Hepatitis Awareness

The speaker discusses the importance of education and community outreach in raising awareness about hepatitis. They mention a program called 'WOM' where women who are positive for hepatitis B become ambassadors to educate others. The speaker encourages listeners to educate others about the disease and to dispel myths about transmission. They also highlight the need for healthcare professionals to be vigilant about potential transmission in clinical settings and the importance of early treatment to prevent the progression to more severe conditions.

15:05

💉 Vaccination and Treatment Options for Hepatitis

The paragraph delves into the availability of vaccines for hepatitis B and the lack of a vaccine for hepatitis C. It mentions the inclusion of the hepatitis B vaccine in the national immunization schedule for newborns and the availability of catch-up schedules for adults. The speaker addresses the absence of a hepatitis C vaccine but notes the existence of effective treatments, such as direct-acting antivirals, which can cure the infection in most cases. They also discuss the importance of testing for hepatitis C, especially for those who have undergone surgeries or procedures where there may have been a risk of exposure.

20:06

🌟 Future Aspirations for Hepatitis Management

The speaker shares their aspirations for the future of hepatitis care and management, advocating for a shift from selective treatment to treating all infected individuals to prevent further transmission. They express hope that by 2030, a global approach similar to that for HIV will be adopted for hepatitis B and C, treating all infected individuals regardless of whether they show symptoms of the disease. The speaker envisions a future where new generations are free from hepatitis B and C, thanks to widespread vaccination and treatment.

Keywords

💡Viral Hepatitis

Viral Hepatitis refers to a group of infectious diseases that affect the liver, caused by viruses. In the context of the video, it is a significant public health issue, particularly in India, where the focus is on combating Hepatitis B and C. The video discusses the global status and impact on public health, emphasizing the need for critical actions such as vaccination and treatment to effectively control the spread of the disease.

💡Hepatitis B and C

Hepatitis B and C are the two most common types of viral hepatitis that lead to chronic infections. As mentioned in the script, 96% of the 1.3 million hepatitis-related deaths globally are due to these two types. The video highlights the importance of distinguishing between infected and diseased patients and the effectiveness of treatments available for both conditions, especially Hepatitis C, which can be cured within 12 weeks with the right medication.

💡Vaccination

Vaccination is a crucial preventive measure against viral hepatitis, specifically Hepatitis B. The script emphasizes the need for immunization, as it is one of the most effective ways to prevent the spread of the disease. The World Health Organization's strategy includes increasing vaccination coverage as a key measure to combat viral hepatitis [^1^].

💡Treatment

Treatment for viral hepatitis, especially for Hepatitis B and C, is discussed in the video as an essential component of managing the disease. For Hepatitis B, treatment involves virus suppression, while Hepatitis C can be cured with antiviral drugs within a few months. The script mentions that India has a national program providing free testing and treatment for Hepatitis C, highlighting the importance of public awareness and access to these treatments.

💡Public Health Impact

The impact of viral hepatitis on public health is a central theme of the video. It discusses the global status of the disease, particularly in India, where the burden of Hepatitis B and C is significant. The script underscores the need for awareness and action to reduce the disease's impact, including the importance of early detection, screening, and treatment.

💡Chronic Infections

Chronic infections, such as those caused by Hepatitis B and C, persist for a lifetime unless treated. The script explains that unlike Hepatitis A and E, which the body can clear, Hepatitis B and C require lifelong treatment or can be cured with the right medication. This concept is important for understanding the long-term management and public health implications of viral hepatitis.

💡Awareness

Raising awareness is highlighted in the script as a critical action needed to combat viral hepatitis. The video discusses the importance of educating the public about the disease, its transmission, prevention, and treatment options. It also emphasizes the need to challenge stigma and misconceptions about the disease to encourage people to get tested and treated.

💡National Viral Hepatitis Control Program

The script mentions India's National Viral Hepatitis Control Program, which was launched in 2018 to provide free testing, treatment, and monitoring for Hepatitis C. This program is an example of a government initiative aimed at reducing the disease's burden and improving public health outcomes for those affected by viral hepatitis.

💡Stigma

Stigma associated with viral hepatitis is discussed in the script as a significant barrier to testing and treatment. The video talks about the negative mindset and social implications for those infected, which can lead to isolation and reluctance to seek help. Addressing this stigma is crucial for encouraging people to get tested and treated and for promoting a better understanding of the disease.

💡Prevention

Prevention measures for viral hepatitis, including vaccination and safe practices such as avoiding risky behaviors that can lead to infection, are discussed in the script. The video emphasizes the importance of early detection and prevention to reduce the disease's spread and improve overall public health.

Highlights

Global status of viral hepatitis, particularly in India, and its significant impact on public health.

96% of 1.3 million hepatitis-related deaths are due to hepatitis B and C, which are chronic infections.

Hepatitis B treatment aims to suppress the virus, with clearance being rare, similar to HIV.

The importance of differentiating between infected and diseased patients in the context of hepatitis.

Hepatitis C can be cured with very effective drugs within about 12 weeks.

India's National Viral Hepatitis Control Program offers free testing, treatment, and monitoring since 2018.

The need for increased public awareness and participation in combating hepatitis.

The importance of testing for hepatitis C, especially among high-risk groups.

The role of Hepatitis B in causing liver cancer and the need for early treatment.

The potential of using public figures like Amitabh Bachan to raise awareness about hepatitis.

The progress and challenges of the National Viral Hepatitis Control Program in India.

The need for better prioritization of hepatitis prevention, screening, and treatment in healthcare systems.

The importance of early detection and treatment in reducing liver cancer risks associated with hepatitis B and C.

The role of women as ambassadors in raising awareness and combating hepatitis, especially among women who are hepatitis B positive.

The aspiration for a global shift towards treating all hepatitis B and C patients by 2030.

The importance of vaccination for hepatitis B and the absence of a vaccine for hepatitis C.

The future hopes for the elimination of hepatitis, with a focus on early detection, treatment, and vaccination.

Transcripts

[Music]

so um since we're talking about

hepatitis can you share a global status

of viral hepatitis particularly in India

and its impact on Public Health what are

the most critical action needed to

combat viral hepatitis effectively like

we talked you said the vaccination

immunization is required and because we

talking about for this year's theme is

time to take action time to take action

against hepatitis to protect our

world yes uh hepatitis 96% of the deaths

of the 1.3 million deaths which which

occur due to Hepatitis B and C are of

all the hepatitis deaths 96% are because

of hepatitis B and C let me tell you a

important

part uh the bloodborn viruses B and C

are chronic infections chronic means

body cannot clear them Hepatitis A and E

they are cleared by body but B and C and

D they persist for your life life unless

treated Hepatitis B the treatment is to

suppress the

virus clearance is rare like in

HIV so in Hepatitis B if you give the

drug it will supress the virus but if

your virus is suppressed you're as good

as anybody and we therefore need to

differentiate infected from diseased

patients so 30 million are infected Ed

but the disease will occur in 1 to 10%

of

them but the the mindset of the

remaining is so bad that they feel that

oh something has happened I got two

patient subjects yesterday one was 32

years a lady and one was a boy who was

37 both had not

married because they thought they are

sick so it is so important for us to say

we have so many

infections so having an infection is not

equivalent to

disease I would say for Hepatitis B and

C for policy matters hepatitis C is

treated by drugs we have very effective

drugs they can clear cure you of the

hepatitis C in about 12 weeks time they

are oral drugs you take a pill a day for

3 months finished and 90 95% clearance

if you have hepatitis C and if you get

the drugs then chances of curosis liver

cancer all of them decrease and good

part is India has a national viral

hepatitis control program from 2018 now

it will be 6 years and nadas sa had

launched it at that time and it is free

hepatitis C drugs are free very few

countries in the India in the world have

this privilege for patients the testing

is free the treatment monitoring

everything is free so if you know of

somebody who has hepatitis C please help

them our Hepatitis B the treatment is

effective you take a pill a day the

yearly cost may not be more than 4,000

rupees or so and the virus is suppressed

then you are as good as anybody the risk

of curosis the risk of liver cancer

significantly decreases so what we need

to do is to take it in your hands don't

depend always on doctors or on the

governments or policies decide if I have

Hepatitis B I must get rid of it if not

get the virus suppressed if I have

Hepatitis C I will get it cured because

they are effective drugs I will not let

have my body go to the stage of curosis

or cancer and even if it occurs you have

transplant you have every possibility so

the deaths can be reduced but by

awareness but if you are

late then like blood vit or jaundice and

others then it is a different situation

now the next part of your thing is about

the

policies I think India is amongst the

very few countries despite being so

large is to have a powerful National

viral hepatitis control program but it

needs to be more you know visible like

my my desire is like the Prime Minister

sometimes says for

TB the number of deaths due to Hepatitis

B are no less maybe more in fact the who

says every 30 seconds there is a person

who is dying due to Hepatitis B so like

in last 20 minutes 40 people have died

due to Hepatitis B somewhere in the

world and the number of deaths due to

Hepatitis B are not less than combined

deaths by TB and malaria so you put TB

and malaria where we have more

visibility why not more visibility more

awareness like your campaign for

Hepatitis B and trying to eliminate it

and also the empathy to you know support

them is absolutely necessary we have to

eliminate we just don't have to control

have to get rid of it we have to do that

sir and Sir like you mentioned how uh

prime minister emphasizes on TB and more

than that more deaths happens because of

hepatitis so I think I was very small I

I still remember that people got more of

awareness about TV in fact of when I was

78 or 10 years around I got to know

about TV how because of a public

advertisement Mr amitab batan uh was

into a public awareness campaign

advertisement in which he talked about

TV how it is transmitted what other the

solutions we have and stuff like that I

think these kind of strong campaigns we

need for hepatitis as well that can

raise awareness on this and you know can

uh can make more aware people about this

absolutely and as doctors like you we

have in our country that is great but

more than that I believe people watch

more of actors and then they make impact

on people got the right person amitab

bachan has Hepatitis B exactly and he

did a campaign once or twice so will you

go to him and tell him again you go to

amitab batan G and then say Sir one more

time and every time and be with people

let us see the elimination part in case

he's hearing or has some approach on

this video I think it will he is one of

the best you know known persons and his

voice would make a difference truely sir

thank you so we also talked about

National viral hepatitis control program

uh in along with that I want to know the

views on that and how far it has

progressed and what necessary steps

needs to be taken to combat hepatitis to

achieve Countrywide elimination of

hepatitis C by 2030 which is the program

aims for and how can healthare system

and government better

prioritize hepatitis prevention

screening and treatment especially in

resource oriented constraint settings

well hepatitis C I think the government

did

everything uh they provided the drugs I

know that they have not been adequately

used by people uh the screening the

virus the RNA everything is free what is

lacking is the public

participation yeah what is lacking is we

hardly have you know 10 to 15% of the

infected India has 7 million lakh

estimate and we have hardly treated

maybe few

lcks so I would like to say that the

testing the knowledge about hepatitis C

is very important all those who got

vaccination like small pox and others

all diabetics who get injections all

those who are

repeatedly using drugs IV drug users and

they share their needles and syringes

all that group must be tested I already

told you that hepatitis C testing should

also be done in those with dialysis

those who got blood transfusion before

99 or maybe even 2005 till then the

blood banks were not very effective our

testings were not so I would say uh this

is called

recall then all blood banks who find

anybody positive for BNC should inform

the person that please come and get

tested all these are part of the viral

hepatitis control program but the public

participation for that needs to be

energized and through interviews like

you siman it will make a difference for

Hepatitis B I already told you high risk

groups so ensure if you are listening

this ensure if your friends are probably

susceptible pass this message each one

of you please listen and educate 10 and

that person should educate another 10

and all these schools should have a

competition maybe for a week yesterday

we had a competition here almost 200

students participated you will be amazed

their knowledge they knew all about wh

guidelines of 2024 a sixth class student

made a rubic you know puzzle using rubic

cubes on hepatitis so what I'm saying is

each one of you who is listening uh go

down to the school levels and don't be

scared you know it hepatitis BNC they

don't come by eating together or shaking

hands and all that

or so don't be scared get treated body

FL one must remember like if you are

infected sometimes saliva has lot of

hepatitis B not C too much or your if

you have an injury and you're positive

it is and any Doctor Who is Hepatitis B

should definitely disclose to the

patient or get virus negative before you

know he can transmit the virus so these

are some of the tips that I have given

you the viral hepatitis control program

in India has been you know somewhat it

was our own ilbs was lucky to be as a wh

Center to help in the conception to

creation and now we feel that the

government has done very well but uh the

public

participation awareness the stigma they

are the bigger blocks and we have to

overcome we started a program called wom

wom is women who are he is be positive

women who are positive become the

ambassadors suppose I am a woman and I

am Hepatitis B positive I would not go

and tell my husband the baby is born I'm

so scared because you go for anal

checkup in a clinic and they say your

hepatitis be positive now this woman

cannot go home she is so

scared such women those who have

survived all this then we have been

running it for almost now 20 years this

program and these uh women are made as

an

ambassador 100 200 of them will go and

say don't worry this is not your problem

but if you are talking to everyone you

may save many many more and their family

lives can improve so it is a whole of

society

approach the infection is deadly the

infection is problematic the infection

is a cause of concern but if we are

standing together and our message is

clear I think so they are the best

people to spread message because they

have experienced it they have gone

through it gone through it and they have

lived the agony they have lived the

despair the

isolation you know we we have a study

called beat b how do you beat the

Hepatitis B because people come and

doctors say say no no you come after one

year because you're not fit to take

treatments I'm trying to get the

guidelines Chang because you ask the

agony of the patient his isolation he

can't

sleep B is a DNA

virus and disease disease treatment work

treatment

orus and it is gone and you have a

strong mind all those who have not

married find someone if the spouse

likely spouse has any issues doctors

like me will solve this problem but get

married in

24 latest by

25 great okay so since we're talking

about suppressing the hepatitis and we

don't talked about all the types of

hepatitis we have a b c d and e so uh I

have few question regarding vaccinations

one do we have vaccination for all these

five hepatitis second you talked about

immunization and vaccinations and how we

can eradicate through vaccinations so do

actually the vaccination card the plan

of a newborn baby when when the baby is

born they get in 2 months 3 months and

every month they have scheduled some

vaccines so so does that also include

the hepatitis yes it does include

Hepatitis B in fact it is part of the

National schedule and now there are new

five in one pentavalent vaccines have

come which included again dpia whatever

meil so all these vaccines are part of

the National schedule and the cards are

given even for adults you will have 013

016 schedule is available and uh the

vaccine especially Healthcare workers

should get their antibody done not rest

of the population that is done now

hepatitis C since you asked does not

have a vaccine okay B has a vaccine a

has a vaccine but not C it's a difficult

RNA virus like Corona it was so

difficult but that was a global Calamity

so people developed now they're working

on a mRNA vaccine for

C but C the good part is that it is

generally quiet and the treatable

curable the bad part is that people are

not aware like for example people got

cesarian sections they got hysterctomy

or they got a prostate surgery long ago

now they are coming with Advanced liver

disease due to hepatitis C or a cancer

due to Hepatitis C so one more time

anybody who's got a surgery or a

procedure done anytime I would say don't

worry about 99 or 2005 do get your

hepatitis C test if it is the RNA is

positive get treated on that the

hepatitis A vaccine is uh given in all

the countries developed countries but in

India generally the kids have Hepatitis

A by food and water so they are already

immunized hepatitis A the immunity is

lifelong

but now wealth is there in India

everywhere so they all carry their

bottles and they don't drink and hygiene

Theory I would say hepati is a vaccine

in those who are somewhat Middle High

upper middle or Rich class they should

get the vaccine done foreigners

Travelers they get Hepatitis A vaccine

Hepatitis E vaccine is not there so we

have to be careful that in Winters and

other things we have good proper hype

portable good drinking water and food is

not exposed and handled by poor people

so you

protect I those are very handy dips

which we can take the time okay so and

uh what are the options available

available for people who are diagnosed

with Hepatitis B and C the treatments

available like you said a we all are

immunized by our birth if a person gets

them and B we also have but C is

something yeah see the drugs are

available there are two drugs SOS and

wellas it comes as or DEET these are the

drugs they are given in the National

program also at least soft and DEA and

by taking that your 90% chance of

getting rid of the virus and uh the

drugs are not expensive India has some

of the cheapest the best generic

medication uh Pharmacy and hepatitis B

drugs are tenob t and Ana these drugs

are available and they are genetics are

very cheap in fact India exports to

every country and they are safe so all

these drugs are generally safe but I

would say we do see in a given week and

in India the liver cancers due to B andc

are is still a problem if patient has

curosis he needs a treatment for liver

disease with a specialist care and if

there is a cancer then also specialist

care sometimes you require transplant

for BNC which is readily done very

successful programs so I think those who

have an advanced disease are uh treated

in a specialized Center but our aim is

early detection early screening and uh

you know treating them early enough and

preventing those by proper vaccination

if we take these steps clearly and

policies which are very clear are

adopted uh by all stakeholders whether

you drug user or dialysis groups and

others I think we can prevent hepatitis

C we should be able to eliminate maybe

if not 2030 uh within the next few years

or so but those who are hidden the

biggest problem is where are those

people so going ahead we have come to

end of this awareness program I want to

know your views your hopes and

aspirations for the future of hepatitis

care and management both in India and

globally you just told us uh you know

diagnosing them making them people will

identify who are they treating them

eradicating it but the aspirations ahead

for

that yeah actually Hepatitis B has been

treatment has been Complicated by

doctors uh they make guidelines whom to

treat and whom not to treat this guy has

fibrosis so he should be treated his DNA

is high he should be treated his liver

has inflammation like his sgbt is high

he should be treated others are just

watched because they know that out of

100 people maybe 10 will have disease so

they want to treat the disease they do

not want to treat the

infected but my opinion is different and

my my opinion is that the infected will

give the infection to others and every

year several lacks of new Hepatitis B

are detected I mean infected so in my

opinion all infected and all diseased

all of them should be treated so my

Approach is from treat

select to treat all yeah and this I have

been proposing for last 4 years or so

and I'm happy to say that the Chinese

associations have moved a little bit

that side wh has moved a little towards

this side and my feeling my aspiration

is by 2030 globally like HIV where we

treat

all we will treat all for Hepatitis B we

treat all hepatitis C we don't isolate

you have the virus but no disease we

treat whether you have infected or

infected plus disease

in Hepatitis B also we should treat the

infected and anybody who Hepatitis B

positive and those who are diseased both

together so that the pool of infected

and the pool who are carrying the virus

to transmit it to the others disappears

if we take this

policy we will require 65 years more or

70 years more to get rid of heati by end

of this Century we can be called because

all newborns will be protected yes and

all infected will be treated and average

age of Indian is 70 years so you require

a complete new generation of Indians who

are free of hepatitis B they are living

without fear of B or C and then there's

no scope of hepatitis yes no scope you

are immunized you're vaccinated

finished okay that's great sir thank you

so much Dr serin for for your valuable

insights your contribution you have made

to this campaign of public Awareness on

the occasion of world hepatitis day it

matters a lot because all these uh tips

treatment options uh future plans are

coming from the expert of this field so

thanks a lot for your time and your

valuable Insight it matters a lot thank

you siman and thank you Shas both of you

for coming here and it's a pleasure I

hope through you the message goes and if

there is something wrong with I have

said get back to me and say Doc you're

wrong here doc you should improve I'm

ready but I committed sure sir thank you

thanks a lot thank you